Indian Health Service “To raise the physical, mental, social, and spiritual health of American Indians, and Alaska Natives to the highest level.”
IHS Mission Indian Health Service (IHS), an agency within the U. S. Department of Health and Human Services, is responsible for providing Federal Health services to American Indians and Alaska Natives. It is the principle Health Care provider and Health Advocate for Indian people. Provider of a comprehensive Health Care Delivery service to 2.2 million American Indians and Alaska Natives who belong to 567 Federally Recognized Tribes within 35 states.
Purchased & Referred Care
Purchased & Referred Care Services are those Healthcare needs that are not available at an IHS or Tribal Facility, and utilize an outside source for Medical/Dental services. Purchased & Referred Care (PRC) funding is available ONLY after all Alternate Resources, (Medicaid, Medicare, State and/or Private Insurance) have been used. PRC is the PAYOR OF LAST RESORT. This is NOT an entitlement program. PRC is managed in a way that care of the most urgent needs COME FIRST, based on medical priority/necessity.
There are five levels of MEDICAL PRIORITY:
LEVEL I: Emergency - Threat to life, limb, senses, e.g., auto accident, cardiac episodes
LEVEL II: Preventive Care Services-e.g., diagnostic tests, labs, x-rays
LEVEL III: Primary and Secondary Care Services-e.g., family practice medicine, chronic disease management
LEVEL IV: Chronic Tertiary and Extended Care Services– e.g., Skilled Nursing Care LEVEL V: Excluded Services e.g., Cosmetic Surgery
Eligibility
One must be an Enrolled Tribal member or descendant in the first or second degree AND live within the Contract Health Service Delivery Area (CHSDA) at this current time.
A patient MUST meet the Eligibility criteria, Medical Priority level, Notification Requirements , AND use of Alternate Resources to receive services.
Visit your PRC Program and bring with you; Two Forms of Identification, (State and Tribal) any and ALL Insurance Cards, plus VA Cards.
IHS Shinnecock Service Unit is located in the lower level of the Shinnecock Health Clinic, 101Church Street, Shinnecock Territory.
Office Hours: Monday-Thursday 8:30 am-6pm Friday 8:30am –4:00 pm
Referrals
A patient MUST have Prior Authorization for PRC Funding, or in the case of a true emergency, must NOTIFY their IHS Program within 72 hours of an emergency admission. For Elders (65 and older) or those who are disabled, there is a 30 day time frame from admission to notification of your IHS program.
Referrals DO NOT automatically authorize payment for requested Medical/Dental care. They are reviewed by Area Office Personnel to determine whether the requested services meet the Medical Priority level, all eligibility requirements, and if funds are readily available for payment.
Please call your PRC program prior to any follow up appointments, or referral to another specialist/facility outside of Pre-Authorized services.
Should you be denied payment of services, you will receive a written notice within 5 days of that denial. Your IHS program will further discuss the Denial Process should you be denied any requested services